2021-06-18T12:16:17-05:00 2020-12-31 381337372 BEENE GARTER LLP 56 GRANDVILLE AVE SW STE 100 GRAND RAPIDS MI 49503 990 2020-01-01 200602574 HOLLAND COMMUNITY HEALTH CENTER HOLL 6163943788 336 S RIVER AVE HOLLAND MI 494233326 CARRIE LOMBARDI BOARD MEMBER 6163943788 2021-06-07 1 CARRIE LOMBARDI 999009999 HOWARD L CUTLER CPA P00292927 6162355200 2021-06-07 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CARRIE LOMBARDI 336 S RIVER AVE HOLLAND MI 494233326 1986263 0 X N/A X 2004 MI TO PROVIDE ACCESS TO QUALITY PRIMARY HEALTH CARE FOR ALL MEMBERS OF THE COMMUNITY WITH BOTH RESPECT AND COMPASSION. 7 6 0 50 0 0 832172 708833 1236171 1277430 0 0 0 0 2068343 1986263 0 0 0 0 0 0 0 0 0 2068343 1986263 2068343 1986263 0 0 295233 515435 295233 515435 0 0 TO IMPROVE THE HEALTH OF THE PATIENTS IN THE HOLLAND COMMUNITY BY PROVIDING QUALITY HEALTH CARE REGARDLESS OF LANGUAGE, FINANCIAL OR CULTURAL BARRIERS; THEREBY ASSURING THAT PRIMARY HEALTH CARE IS ACCESSIBLE TO ALL RESIDENTS OF THE AREA. 0 0 1877463 1277430 PROVIDED APPROXIMATELY 11,800 PATIENT HEALTH CARE VISITS. 1877463 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 0 0 MI X JIM JUNEWICK 6164866708 4420 44TH ST SE KENTWOOD MI 49512 DALE SOWDERS CHAIR 1.00 X X 0 0 0 SAMIR RAJANI MD DIRECTOR 1.00 X 0 0 0 JEAN MARTIN DIRECTOR 1.00 X 0 0 0 SUE FROST TREASURER/SECRETARY 40.00 X X 0 83068 0 ALLISON RUND MD DIRECTOR 1.00 X 0 0 0 PATTI VANDORT VICE CHAIR 1.00 X X 0 0 0 CARRIE LOMBARDI DIRECTOR 1.00 X 0 0 0 0 83068 0 0 0 0 0 SPECTRUM HEALTH MEDICAL GROUP 648 MONROE NW SUITE 300 GRAND RAPIDS MI 49503 SEE SCHEDULE O 1626019 1 685824 23009 708833 PATIENT FEES 621400 1103496 1103496 PHYSICIAN INCENTIVES 621400 173934 173934 1277430 1986263 1277430 0 0 X 75000 75000 21000 21000 1551019 1551019 218864 218864 78135 78135 235 235 5776 5776 1980 1980 16718 16718 BANK SERVICE CHARGE 12800 12800 OUTSIDE SERVICE 3677 3677 MISCELLANEOUS 1059 1059 1986263 1877463 108800 0 186116 427984 96578 76892 19799 9240 12539 10559 295233 515435 295233 515435 0 295233 515435 X 0 0 295233 515435 0 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19799 9240 10559 10559 X 2270568 284305 284305 1986263 0 1986263 2270568 284305 284305 1986263 0 1986263 PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS DETERMINED THE CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER PROVISIONS OF CODE SECTION 501(C)(3) WHEREBY ONLY UNRELATED BUSINESS INCOME, AS DEFINED BY SECTION 509(A)(1) OF THE CODE, IS SUBJECT TO FEDERAL INCOME TAX. THE CENTER CURRENTLY HAS NO UNRELATED BUSINESS ACTIVITY. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. IN ADDITION, THE CENTER QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). TAX POSITIONS TAKEN ARE ASSESSED FOR UNCERTAINTY AND A PROVISION MAY BE RECORDED IF A TAX POSITION IS NOT LIKELY TO BE SUSTAINED UPON EXAMINATION. DR RAJANI DR RUND S FROST AND EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC 1887267 SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC. 0 DALE SOWDERS PATTI VANDORT EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC 77996 HH LEASES FACILITY TO HCHC 0 SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF INTERESTED PERSON: DR. RAJANI, DR. RUND, S. FROST, AND C. LOMBARDI.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC(C) DESCRIPTION OF TRANSACTION: SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC.(A) NAME OF INTERESTED PERSON: DALE SOWDERS AND PATTI VANDORT(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC (C) DESCRIPTION OF TRANSACTION: HH LEASES FACILITY TO HCHC FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITHIN THE GOVERNING BODY FORM 990, PART VI, SECTION B, LINE 11B CARRIE LOMBARDI (BOARD MEMBER) AND JAMES JUNEWICK (FINANCIAL REPORTING MANAGER) REVIEW THE FORM PRIOR TO FILING. THE COMPLETED AND FILED FORM 990 IS PRESENTED TO THE BOARD, HOWEVER, THERE IS NO REVIEW PROCESS BY THE ENTIRE BOARD OF DIRECTORS OF THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE BOARD MEMBERS SIGN THE CONFLICT OF INTEREST FORMS. THE COMPLETED FORMS ARE SENT TO SPECTRUM HEALTH'S RISK AND COMPLIANCE DEPARTMENT WHICH REVIEWS THE FORMS FOR ANY POTENTIAL ISSUES THAT MAY ARISE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART IX, LINE 11G PROVIDER AND CLINIC SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 1,551,019. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,551,019. FORM 990 PART XII, LINE 2C THERE IS NO FORMAL COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, HOWEVER, THE BOARD OF DIRECTORS SERVES THIS FUNCTION. THERE HAS BEEN NO CHANGE OF THIS PROCESS FROM THE PRIOR YEARS. FORM 990, PART VII, SECTION A, LINE 1 DALE SOWDERS RECEIVES COMPENSATION FOR HIS WORK AT HOLLAND HOSPITAL, WHICH IS A FOUNDING MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. ALLISON RUND, M.D. RECEIVES COMPENSATION FOR HER WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SAMIR RAJANI, M.D. IS COMPENSATED FOR HIS WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SUE FROST IS COMPENSATED BY SPECTRUM HEALTH MEDICAL GROUP FOR HER WORK AT HOLLAND COMMUNITY HEALTH CENTER. SPECTRUM HEALTH MEDICAL GROUP IS A RELATED ENTITY TO HOLLAND COMMUNITY HEALTH CENTER. SUE IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. CARRIE LOMBARDI IS COMPENSATED BY SPECTRUM HEALTH MEDICAL GROUP FOR HER WORK AT HOLLAND COMMUNITY HEALTH CENTER. SPECTRUM HEALTH MEDICAL GROUP IS A RELATED ENTITY TO HOLLAND COMMUNITY HEALTH CENTER. CARRIE IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 13-14 HCHC DOES NOT HAVE A FORMAL WRITTEN WHISTLEBLOWER POLICY OR WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. THEY ADHERE TO THE POLICIES THAT HAVE BEEN SET FORTH BY SPECTRUM HEALTH MEDICAL GROUP. FORM 990, PART VII, SECTION B, LINE 1(B) SPECTRUM HEALTH MEDICAL GROUP PAYS ALL OPERATING EXPENSES OF HCHC AND IS REIMBURSED BY HCHC. HOLLAND COMMUNITY HOSPITALS 602 MICHIGAN AVENUE HOLLAND MI 49423 382800065 HEALTH CARE NEEDS OF THE HOLLAND COMMUNITY MI 501(C)(3) 3 N/A 0 SPECTRUM HEALTH PRIMARY CARE PARTNERS DBA SPECTRUM HEALTH MEDICAL GROUP 648 MONROE NW SUITE 300 GRAND RAPIDS MI 49503 381358164 TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. MI 501(C)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 SPECTRUM HEALTH MEDICAL GROUP M 1626019 COSTS PAID SPECTRUM HEALTH MEDICAL GROUP P 261248 COSTS PAID HOLLAND COMMUNITY HOSPITAL C 685824 PAYMENTS RECEIVED AND DUE HOLLAND COMMUNITY HOSPITAL K 77996 RENT PAID